HB 1430: Community Health, Department of; license supportive senior housing communities; provide

House Bill 1430

By: Representatives Taylor of the 173rd, Dempsey of the 13th, Burchett of the 176th, Newton of the 127th, and Cooper of the 45th

A BILL TO BE ENTITLED

AN ACT

To amend Article 1 of Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to the regulation of hospitals and related institutions, so as to provide for the Department of Community Health to license supportive senior housing communities; to provide for definitions; to provide for type of residents; to provide for the employment of certified medication aides; to provide for a written care plan for residents; to provide for staffing and training requirements; to provide for financial stability requirements; to provide for the development of rate methodology; to provide for a waiver request to be submitted; to amend Titles 10, 16, 25, 26, 31, and 33, relating to commerce and trade, crimes and offenses, fire protection and safety, food, drugs, and cosmetics, health, and insurance, respectively, so as to provide for supportive senior housing communities in certain definitions, protections, and procedures; to provide for unfair or deceptive practices; to provide for the protection of elder persons and identity fraud; to provide for fire and safety requirements; to provide for durable medical equipment supplier license requirements; to provide for communications with ombudsman; to provide for notice of deficiency; to provide for the Department of Community Health to establish meaningful distinctions between the levels of care at licensed facilities; to provide for COVID-19 requirements; to provide for employer based programs; to provide for influenza education information; to provide for residential care facilities for the elderly; to provide for hospice and palliative care; to provide background checks; to provide for the ombudsman program; to provide for remedies and protections of residents; to provide for the drug repository program; to provide for continuing care providers and facilities; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

PART I

SECTION 1-1.

Article 1 of Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to the regulation of hospitals and related institutions, is amended by revising Code Section 31-7-12.6, which is reserved, as follows:

"31-7-12.6.

(a) As used in this Code section, the term:

(1) 'Direct care staff person' shall have the same meaning as set forth in Code Section 31-7-12.2.

(2) 'Limited nursing services' shall have the same meaning as set forth in Code Section 31-7-12.2.

(3) 'Nursing staff person' means a certified nurse aide, certified medication aide, licensed practical nurse, registered nurse, registered professional nurse, or advanced practice registered nurse.

(4) 'Supportive senior care' means and includes:

(A) Personal services, which includes, but is not limited to, individual assistance with or supervision of self-administered medication and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting;

(B) The administration of medications by a medication aide in accordance with this Code section;

(C) The provision of limited nursing services;

(D) Weekly laundry and housekeeping services;

(E) Periodic scheduled medical transportation; and

(F) Social and recreational programming.

(5) 'Supportive senior housing community' means a facility with a minimum of 25 beds and a maximum of 150 units in which each resident has his or her own apartment that is leased under a separate agreement and where more than 50 percent of the resident population is composed of recipients of medical assistance as defined in Code Section 49-4-141 and that is licensed as a supportive senior housing community pursuant to this article.

(b) The department is authorized to license supportive senior housing communities to provide supportive senior care to individuals as established in this Code section.

(c) A supportive senior housing community shall not admit or retain an individual who is in need of 24 hour per day comprehensive nursing care or continuous medical or nursing care; provided, however, that supportive senior care may be provided by direct care staff persons, limited nursing services may be provided by direct care staff persons or nursing staff persons, and certain medications may be administered by certified medication aides pursuant to subsection (d) of this Code section.

(d)(1) A supportive senior housing community may employ certified medication aides for the purpose of performing the technical aspects of the administration of certain medications in accordance with this subsection. A supportive senior housing community that employs one or more certified medication aides shall have a safe medication and treatment administration system that meets all the requirements of this subsection.

(2) A supportive senior housing community shall not employ an individual as a certified medication aide unless such individual is listed in the medication aide registry established and maintained by the department pursuant to paragraph (2) of subsection (g) of Code Section 31-7-12.2, is in good standing with the department, and has met all of the qualifications in paragraph (3) of such subsection.

(3) A supportive senior housing community shall annually conduct a comprehensive clinical skills competency review of each certified medication aide employed by such community.

(4) A certified medication aide who meets the criteria established in this Code section shall be permitted to perform the following tasks in a supportive senior housing community in accordance with the written instructions of a physician:

(A) Administer physician ordered oral, ophthalmic, topical, otic, nasal, vaginal, and rectal medications;

(B) Administer insulin, epinephrine, and B12 pursuant to physician direction and protocol;

(C) Administer medications via a metered dose inhaler;

(D) Conduct finger stick blood glucose testing following established protocol;

(E) Administer a commercially prepared disposable enema as ordered by a physician;

(F) Assist residents in the supervision of self-administration of medications; and

(G) Administer liquid morphine to a resident of such community who is the patient of a licensed hospice, pursuant to a hospice physician's written order that contains specific instructions for indication, dosage, frequency, and route of administration, provided that the licensed hospice consents to the use and administration of liquid morphine as described in this subparagraph. The certified medication aide shall observe and document the resident's need for all 'as needed' (PRN) liquid morphine in such resident's record, and such indications of need may include verbalizations of pain, groaning, grimacing, or restlessness. The initial dose of any liquid morphine administered pursuant to this subparagraph shall be administered and assessed by a licensed hospice healthcare professional to observe and address any adverse reactions to such medication. Such community shall ensure that any certified medication aides who will be administering liquid morphine to any hospice patients in such community pursuant to this subparagraph receive adequate training from a licensed hospice on the safe and proper administration of liquid morphine prior to such administration and on an annual basis thereafter. Such community shall maintain documentation of all training provided and shall adhere to all security and storage requirements for liquid morphine required under state and federal law, including but not limited to any rules promulgated by the department. Notwithstanding the foregoing, the supply of liquid morphine on-site at such community shall be limited to no more than 50 ml for each hospice patient in the assisted living community and shall only be administered under limited circumstances when a licensed hospice healthcare professional is not otherwise available. The department shall promulgate rules and regulations to implement this subparagraph.

(5) A certified medication aide shall record in a medication administration record all medications that such medication aide has personally administered to a resident of a supportive senior housing community and any refusal of a resident to take a medication. A certified medication aide shall observe a resident to whom medication has been administered and shall report any changes in the condition of such resident to the personal representative or legal surrogate of such resident.

(6) All medication administered by a certified medication aide in accordance with this subsection shall be in unit or multidose packaging.

(7) A supportive senior housing community that employs one or more certified medication aides to administer medications in accordance with this subsection shall secure the services of a licensed pharmacist to perform the following duties:

(A) Perform a quarterly review of the drug regimen of each resident of such community and report any irregularities to the administrator of such community;

(B) Remove for proper disposal any drugs that are expired, discontinued, in a deteriorated condition, or when the resident for whom such drugs were ordered is no longer a resident;

(C) Establish or review policies and procedures for safe and effective drug therapy, distribution, use, and control; and

(D) Monitor compliance with established policies and procedures for medication handling and storage.

(8) A supportive senior housing community that employs one or more certified medication aides to administer medications in accordance with this subsection shall ensure that each certified medication aide receives ongoing medication training as prescribed by the department. A registered professional nurse or pharmacist shall conduct random medication administration observations on a quarterly basis and report any issues to the administrator of such community.

(e) A supportive senior housing community shall establish a written care plan for each resident. Such care plan shall describe the needs of the resident and how such needs will be met.

(f) A supportive senior housing community shall be required to meet the following staffing and training requirements:

(1) Each direct care staff person in the supportive senior housing community receives initial and annual training covering topics specified by the department to ensure a demonstrated knowledge and understanding of caring for elderly and disabled adults; and

(2) Staff at the supportive senior housing community shall be sufficient in number, qualifications, and training to meet the 24 hour scheduled and unscheduled needs of the residents at such community and to provide supportive senior care and limited nursing services provided at such community. The number, qualifications, and training of staff shall depend on skills required to provide for the specific needs of the residents; provided, however, that the supportive senior housing community meets the following minimum staffing requirements:

(A) At least two on-site direct care staff persons at all times;

(B) An average monthly minimum on-site staffing ratio of one direct care staff person for every 25 residents during all waking hours and one direct care staff person for every 40 residents during all nonwaking hours; and

(C) A registered professional nurse or licensed practical nurse available as follows:

(i) A minimum of eight hours per week when such community has up to 30 residents;

(ii) A minimum of 16 hours per week when such community has between 31 and 60 residents;

(iii) A minimum of 24 hours per week when such community has between 61 and 90 residents; and

(iv) A minimum of 40 hours per week when such community has more than 90 residents.

(g) All supportive senior housing communities shall be required to meet certain financial stability requirements. An applicant or a licensee shall:

(1) Upon initial application for a supportive senior housing community license or upon a change of ownership, provide a financial stability affidavit from a certified public accountant affirming the applicant's or licensee's financial status. The department shall establish a mandatory financial stability affidavit form pursuant to rules and regulations to be used for purposes of this paragraph and shall assess the applicant's or licensee's financial status, in its own discretion, based on such financial stability affidavit;

(2) Provide a minimum of 60 days' written notice to the department and all residents of any impending bankruptcy or property eviction that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight; and

(3) Provide a minimum of 14 days' written notice to the department and all residents of any impending change of ownership that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight.

(h) The department shall:

(1) Collaborate with industry stakeholders to develop a rate methodology to ensure wide-scale access to supportive senior housing communities. In creating a rate methodology, the department shall verify the adequacy of the rate to support supportive senior housing communities financed with low-income housing tax credits and to satisfy the requisite underwriting metrics for financial viability; and

(2) No later than June 30, 2026, prepare and submit a waiver request to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. Further, upon approval of the waiver, the department shall be authorized to take all necessary steps to implement the terms and conditions of the waiver without any further legislative action.

(i) The waiver provided for in paragraph (2) of subsection (h) of this Code section shall be targeted and limited to individuals who satisfy the following requirements for age, residency status, financial eligibility, and level of care:

(1) Individuals who are 65 years of age or older at the time of initial eligibility determination;

(2) Individuals who are residents of this state and eligible for the state Medicaid program under an approved eligibility category;

(3) Individuals whose countable income does not exceed 300 percent of the benefit rates determined pursuant to Title XVI of the federal Social Security Act for supplemental security income, as adjusted annually, and who meet all other applicable Medicaid financial eligibility requirements, including resource limits, pursuant to federal law and regulation; and

(4) Individuals who meet the nursing facility level of care criteria as defined under the state Medicaid program and in accordance with 42 U.S.C. Section 1396r, 42 C.F.R. Sections 440.40 and 441.301, and other applicable federal regulations. Reserved."

PART II

SECTION 2-1.

Title 10 of the Official Code of Georgia, relating to commerce and trade, is amended in Part 2 of Article 15 of Chapter 1, the "Fair Business Practices Act of 1975," by revising paragraph (26) of subsection (b) of Code Section 10-1-393, relating to unfair or deceptive practices in consumer transactions unlawful and examples, as follows: "(26) With respect to any individual or facility providing personal care services, or assisted living care, or supportive senior care:

(A) Any person or entity not duly licensed or registered as a personal care home, or assisted living community, or supportive senior housing community formally or informally offering, advertising to, or soliciting the public for residents or referrals; or

(B) Any personal care home, as defined in subsection (a) of Code Section 31-7-12, or any assisted living community, as defined in Code Section 31-7-12.2, or any supportive senior housing community, as defined in Code Section 31-7-12.6, offering, advertising, or soliciting the public to provide services:

(i) Which are outside the scope of personal care services, or assisted living care, or supportive senior care, respectively; and

(ii) For which it has not been specifically authorized.

Nothing in this subparagraph prohibits advertising by a personal care home, or assisted living community, or supportive senior housing community for services authorized by the Department of Community Health under a waiver or variance pursuant to subsection (b) of Code Section 31-2-7.

As used in this paragraph, the term: For purposes of this paragraph, 'personal care' means protective care and watchful oversight of a resident who needs a watchful environment but who does not have an illness, injury, or disability which requires chronic or convalescent care including medical and nursing services, and 'assisted living care' includes services provided for in Code Section 31-7-12.2, and 'supportive senior care' includes services provided for in Code Section 31-7-12.6. The provisions of this paragraph shall be enforced following consultation with the Department of Community Health which shall retain primary responsibility for issues relating to licensure of any individual or facility providing personal care services;"

SECTION 2-2.

Title 16 of the Official Code of Georgia Annotated, relating to crimes and offenses, is amended in Article 8 of Chapter 5, relating to protection of elder persons, by revising paragraph (7) of Code Section 16-5-100, relating to definitions, as follows: "(7) 'Long-term care facility' means any skilled nursing facility, intermediate care home, assisted living community, supportive senior housing community, or personal care home subject to regulation and licensure by the Department of Community Health and any community living arrangement licensed by the Department of Behavioral Health and Developmental Disabilities pursuant to Article 1 of Chapter 13 of Title 37."

SECTION 2-3.

Said title is further amended in Article 8 of Chapter 9, relating to identity fraud, by revising paragraph (4) of Code Section 16-9-120, relating to definitions, as follows: "(4) 'Health care records' means records however maintained and in whatever form regarding an individual's health, including, but not limited to, doctors' and nurses' examinations and other notes, examination notes of other medical professionals, hospital records, rehabilitation facility records, nursing home records, assisted living facility records, supportive senior housing community records, results of medical tests, X-rays, CT scans, MRI scans, vision examinations, pharmacy records, prescriptions, hospital charts, surgical records, mental health treatments and counseling, dental records, and physical therapy notes and evaluations."

SECTION 2-4.

Title 25 of the Official Code of Georgia Annotated, relating to fire protection and safety, is amended in Chapter 2, relating to regulation of fire and other hazards to persons and property generally, by revising subparagraph (b)(1)(J) of Code Section 25-2-13, relating to fire safety requirements for buildings or structures presenting special hazards, as follows: "(J) Personal care homes, and assisted living communities, and supportive senior housing communities required to be licensed as such by the Department of Community Health and having at least seven beds for nonfamily adults, and the Commissioner shall, pursuant to Code Section 25-2-4, by rule adopt state minimum fire safety standards for those homes, and any structure constructed as or converted to a personal care home on or after April 15, 1986, shall be deemed to be a proposed building pursuant to subsection (d) of Code Section 25-2-14 and that structure may be required to be furnished with a sprinkler system meeting the standards established by the Commissioner if he deems this necessary for proper fire safety."

SECTION 2-5.

Title 26 of the Official Code of Georgia Annotated, relating to food, drugs, and cosmetics, is amended in Article 1 of Chapter 4, relating to general provisions relative to pharmacists and pharmacies, by revising paragraph (18.1) of Code Section 26-4-5, relating to definitions, as follows:

"(18.1) 'Institution' means any licensed hospital, nursing home, assisted living community, personal care home, hospice, health clinic, or prison clinic. Such term shall include a supportive senior housing community for the limited purpose of state licensure; provided, however, that such community shall not be deemed an institution excluded from home and community based settings under 42 C.F.R. Section 441.530."

SECTION 2-6.

Said title is further amended in Article 3 of Chapter 4, relating to practice of pharmacy, by adding a new paragraph to subsection (g) of Code Section 26-4-51, relating to durable medical equipment supplier license, requirements, exemptions, and rules and regulations, to read as follows:

"(6.1) Supportive senior housing communities;"

SECTION 2-7.

Said title is further amended in Article 13 of Chapter 4, relating to safe medications practice, by revising paragraph (3) of Code Section 26-4-212, relating to definitions, as follows: "(3) 'Institution' means any licensed hospital, nursing home, assisted living community, personal care home, or hospice. Such term shall include a supportive senior housing community for the limited purpose of state licensure; provided, however, that such community shall not be deemed an institution excluded from home and community based settings under 42 C.F.R. Section 441.530."

SECTION 2-8.

Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Article 1 of Chapter 7, relating to regulation of hospitals and related institutions, by revising paragraph

(4) of Code Section 31-7-1, relating to definitions, as follows: "(4) 'Institution' means:

(A) Any building, facility, or place in which are provided two or more beds and other facilities and services that are used for persons received for examination, diagnosis, treatment, surgery, maternity care, nursing care, assisted living care, supportive senior care, or personal care for periods continuing for 24 hours or longer and which is classified by the department, as provided for in this chapter, as either a hospital, nursing home, assisted living community, or personal care home; such term shall include a supportive senior housing community for the limited purpose of state licensure; provided, however, that such community shall not be deemed an institution excluded from home and community-based settings under 42 C.F.R. Section 441.530;

(B) Any health facility wherein abortion procedures under subsections (b) and (c) of Code Section 16-12-141 are performed or are to be performed;

(C) Any building or facility, not under the operation or control of a hospital, which is primarily devoted to the provision of surgical treatment to patients not requiring hospitalization and which is classified by the department as an ambulatory surgical treatment center;

(D) Any fixed or mobile specimen collection center or health testing facility where specimens are taken from the human body for delivery to and examination in a licensed clinical laboratory or where certain measurements such as height and weight determination, limited audio and visual tests, and electrocardiograms are made, excluding public health services operated by the state, its counties, or municipalities;

(E) Any building or facility where human births occur on a regular and ongoing basis and which is classified by the department as a birthing center;

(F) Any building or facility which is devoted to the provision of treatment and rehabilitative care for periods continuing for 24 hours or longer for persons who have traumatic brain injury, as defined in Code Section 37-3-1; or

(G) Any freestanding imaging center where magnetic resonance imaging, computed tomography (CT) scanning, positron emission tomography (PET) scanning, positron emission tomography/computed tomography, and other advanced imaging services as defined by the department by rule, but not including X-rays, fluoroscopy, or ultrasound services, are conducted in a location or setting not affiliated or attached to a hospital or in the offices of an individual private physician or single group practice of physicians and conducted exclusively for patients of that physician or group practice. Such term shall exclude all physicians' and dentists' private offices and treatment rooms in which such physicians or dentists primarily see, consult with, and treat patients."

SECTION 2-9.

Said title is further amended in said article by revising subsection (d) of Code Section 31-7-3, relating to requirements for permits to operate institutions, as follows: "(d)(1) When an application for licensure to operate a personal care home, as defined in subsection (a) of Code Section 31-7-12, or an assisted living community, as defined in Code Section 31-7-12.2, or a supportive senior housing community, as defined in Code Section 31-7-12.6, has been made, the department shall inform the office of the state long-term care ombudsman of the name and address of the applicant prior to issuing authority to operate or receive residents and shall provide to the ombudsman program an opportunity to provide to the department information relevant to the applicant's fitness to operate as a licensed personal care home, or an assisted living community, or a supportive senior housing community.

(2) The department may consider any information provided under this subsection, where verified by appropriate licensing procedures, in determining whether an applicant meets the requirements for licensing.

(3) The department shall promulgate regulations setting forth the procedures by which the long-term care ombudsman program shall report information to the department or its designee as required by this subsection, including a consistent format for the reporting of information, safeguards to protect confidentiality, and specified types of information which shall be routinely provided by the long-term care ombudsman program.

(4) Nothing in this subsection shall be construed to provide any authority to the long-term care ombudsman program to license or refuse to license the operation of a personal care home, or an assisted living community, or a supportive senior housing community."

SECTION 2-10.

Said title is further amended in said article by revising subsection (a) of Code Section 31-7-3.2, relating to notice requirements for cited deficiency, use of regulatory violations in civil actions, and use of survey results in advertisements, as follows: "(a) A personal care home, assisted living community, supportive senior housing community, nursing home, or intermediate care home licensed under this article shall give notice in the event that such facility has been cited by the department for any deficiency for which the facility has received notice of the imposition of any sanction available under federal or state laws or regulations, except where a plan of correction is the only sanction to be imposed."

SECTION 2-11.

Said title is further amended in said article by revising Code Section 31-7-12.3, relating to rules, regulations, and waivers for personal care homes and assisted living communities, as follows:

"31-7-12.3.

The department shall adopt rules and regulations to implement Code Sections 31-7-12, and

31-7-12.2, and 31-7-12.6. Notwithstanding the provision of limited nursing services by assisted living communities and supportive senior housing communities, such rules and regulations shall establish meaningful distinctions between the levels of care provided by personal care homes, assisted living communities, supportive senior housing communities, and nursing homes but shall not curtail the scope or levels of services provided by personal care homes or nursing homes as of June 30, 2011; provided, however, that nothing in this chapter shall preclude the department from issuing waivers or variances to personal care homes of the rules and regulations established pursuant to this Code section. Notwithstanding Code Section 31-7-12.2, the department shall not grant a waiver or variance unless:

(1) There are adequate standards affording protection for the health and safety of residents of the personal care home;

(2) The resident of the personal care home provides a medical assessment conducted by a licensed health care professional who is unaffiliated with the personal care home which identifies the needs of the resident; and

(3) The department finds that the personal care home can provide or arrange for the appropriate level of care for the resident."

SECTION 2-12.

Said title is further amended in said article by revising subsection (b) of Code Section 31-7-12.5, relating to notification and other requirements for COVID-19 infections in personal care homes, as follows:

"(b) Each personal care home with 25 or more beds, each assisted living community, supportive senior housing community, and each nursing home licensed in this state shall:

(1) Inform its residents and their representatives or legal surrogates by 5:00 P.M. the next calendar day following the occurrence of either a single confirmed infection of COVID-19 or another airborne infectious disease identified by the department or the federal Centers for Disease Control and Prevention as a threat to public health, or three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other. Such information shall:

(A) Not include personally identifiable information;

(B) Include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations of the facility will be altered; and

(C) Include any cumulative updates for residents and their representatives or legal surrogates at least weekly or by 5:00 P.M. the next calendar day following the occurrence of any subsequent confirmed infection of COVID-19, or whenever three or more residents or staff with new onset of respiratory symptoms occurs within 72 hours of each other;

(2) Maintain a minimum of a seven-day supply of protective masks, surgical gowns, eye protection, and gloves sufficient to protect all residents and staff;

(3) Maintain and publish for its residents and their representatives or legal surrogates policies and procedures pertaining to infection control and mitigation within their facilities and update such policies and procedures annually; and

(4) As part of the facility's disaster preparedness plan required pursuant to subsection (c) of Code Section 31-7-3 and department rules and regulations, include an epidemic and pandemic plan for influenza and other infectious diseases which conforms to department and federal Centers for Disease Control and Prevention standards that contains the following minimum elements:

(A) Protocols for surveillance and detection of epidemic and pandemic diseases in residents and staff;

(B) A communication plan for sharing information with public health authorities, residents, residents' representatives or their legal surrogates, and staff;

(C) An education and training plan for residents and staff regarding infection control protocols;

(D) An infection control plan that addresses visitation, cohorting measures, sick leave and return-to-work policies, and testing and immunization policies; and

(E) A surge capacity plan that addresses protocols for contingency staffing and supply shortages."

SECTION 2-13.

Said title is further amended in said article by revising subsection (b) of Code Section 31-7-12.8, relating to certification as nurse aide, employer sponsored training and competency examination programs, and provisional practice by military medical personnel, as follows:

"(b) The department shall approve employer based programs sponsored by or offered in assisted living communities, supportive senior housing communities, private home care providers, personal care homes, or other long-term care facilities licensed by the department for certified nurse aide training and competency examination programs as determined by the department."

SECTION 2-14.

Said title is further amended in said article by revising subsections (a) and (b) of Code Section 31-7-21, relating to provision of influenza education information to assisted living community residents, as follows:

"(a) Each assisted living community and supportive senior housing community shall annually provide to each of its residents, no later than September 1 of each year, educational information on influenza disease. Such information shall include, but is not limited to, the risks associated with influenza disease; the availability, effectiveness, and known contraindications of the influenza immunization; causes and symptoms of influenza; and the means in which it is spread. Provision of the appropriate and current Vaccine Information Statement as provided by the federal Centers for Disease Control and Prevention shall be deemed to comply with this subsection.

(b) Nothing in this Code section shall be construed to require an assisted living community or supportive senior housing community to provide or pay for any vaccination against influenza for its residents."

SECTION 2-15.

Said title is further amended in Article 5 of Chapter 7, relating to residential care facilities for the elderly authorities, by revising paragraph (1) of subsection (a) of Code Section 31-7-111, relating to legislative findings, as follows: "(1) There exists in this state a seriously inadequate supply of and a critical need for facilities which can furnish the comprehensive services required by elderly persons in a single location, including, without limitation, residential care and the types of services provided in skilled nursing homes, intermediate care homes, assisted living communities, supportive senior housing communities, and personal care homes (hereinafter referred to as 'residential care facilities for the elderly');"

SECTION 2-16.

Said title is further amended in said article by revising subparagraph (A) of paragraph (7) of Code Section 31-7-112, relating to definitions, as follows: "(A) Any one or more buildings or structures to be used in providing at a single location the comprehensive services required by the elderly, including, without limitation, residential care and the types of services provided in skilled nursing homes, intermediate care homes, assisted living communities, supportive senior housing communities, and personal care homes supplied with all necessary or useful furnishings, machinery, equipment, parking facilities, landscaping, and facilities for outdoor storage, all as determined by the authority, which determination shall be final and not subject to review; provided, however, that no single project or residential care facility shall be required to render all types of services and levels of care referred to above. There may be included as part of any such project all improvements necessary to the full utilization thereof, including, without limitation, site preparation; roads and streets; sidewalks; water supply; outdoor lighting; belt line railroad; railroad sidings and lead tracks; bridges; causeways; terminals for railroad, automotive, and air transportation; transportation facilities incidental to the project; and the dredging and improving of harbors and waterways. However, none of the aforementioned improvements shall be the primary purpose of any project;"

SECTION 2-17.

Said title is further amended in Article 9 of Chapter 7, relating to hospice care, by revising paragraph (4) of Code Section 31-7-172, relating to definitions, as follows: "(4) 'Health care facility' means hospitals; other special care units, including but not limited to podiatric facilities; skilled nursing facilities; intermediate care facilities; assisted living communities; supportive senior housing communities; personal care homes; ambulatory surgical or obstetrical facilities; health maintenance organizations; home health agencies; and diagnostic, treatment, or rehabilitation centers."

SECTION 2-18.

Said title is further amended in Article 10 of Chapter 7, relating to palliative care, by revising paragraph (2) of Code Section 31-7-191, relating to definitions, as follows: "(2) 'Healthcare facility' means hospitals; other special care units, including but not limited to podiatric facilities; skilled nursing facilities; intermediate care facilities; assisted living communities; supportive senior housing communities; personal care homes; ambulatory surgical or obstetrical facilities; health maintenance organizations; home health agencies; and diagnostic, treatment, or rehabilitation centers."

SECTION 2-19.

Said title is further amended in Article 14 of Chapter 7, relating to Georgia Long-term Care Background Check Program, by revising subparagraph (B) of paragraph (8) of Code Section 31-7-351, relating to definitions, as follows:

"(B) An assisted living community required to be licensed under Code Section 31-7-12.2 or a supportive senior housing community required to be licensed under Code Section 31-7-12.6;"

SECTION 2-20.

Said title is further amended in Article 3 of Chapter 8, relating to long-term care ombudsman program, by revising paragraph (2) of Code Section 31-8-51, relating to definitions, as follows:

"(2) 'Long-term care facility' means any skilled nursing home, intermediate care home, private home care provider, assisted living community, supportive senior housing community, or personal care home now or hereafter subject to regulation and licensure by the Department of Community Health."

SECTION 2-21.

Said title is further amended in Article 4 of Chapter 8, relating to reporting abuse or exploitation of residents in long-term care facilities, by revising paragraph (3) of Code Section 31-8-81, relating to definitions, as follows:

"(3) 'Long-term care facility' or 'facility' means any skilled nursing home, intermediate care home, assisted living community, supportive senior housing community, or personal care home now or hereafter subject to regulation and licensure by the department."

SECTION 2-22.

Said title is further amended in Article 5A of Chapter 8, relating to remedies for residents of personal care homes, by revising paragraph (5) of Code Section 31-8-132, relating to definitions, as follows:

"(5) 'Personal care home' or 'home' means a facility as defined in Code Section 31-7-12 and shall include any assisted living community as defined in paragraph (3) of subsection (b) of Code Section 31-7-12.2 and any supportive senior housing community as defined in paragraph (5) of subsection (a) of Code Section 31-7-12.6 that is subject to regulation and licensure by the department."

SECTION 2-23.

Said title is further amended in Article 10 of Chapter 8, relating to drug repository program, by adding a new subparagraph to paragraph (7) of Code Section 31-8-300, relating to definitions, to read as follows:

"(C.1) Supportive senior housing community licensed pursuant to Code Section 31-7-12.6;"

SECTION 2-24.

Title 33 of the Official Code of Georgia Annotated, relating to insurance, is amended in Chapter 45, relating to continuing care providers and facilities, by revising paragraphs (1), (8), and (15) of Code Section 33-45-1, relating to definitions, as follows: "(1) 'Continuing care' means furnishing pursuant to a continuing care agreement:

(A) Lodging that is not:

(i) In a skilled nursing facility, as such term is defined in Code Section 31-6-2;

(ii) An intermediate care facility, as such term is defined in Code Section 31-6-2;

(iii) An assisted living community, as such term is defined in Code Section

31-7-12.2, or a supportive senior housing community, as such term is defined in Code Section 31-7-12.6; or

(iv) A personal care home, as such term is defined in Code Section 31-7-12;

(B) Food; and

(C) Nursing care provided in a facility or in another setting designated by the agreement for continuing care to an individual not related by consanguinity or affinity to the provider furnishing such care upon payment of an entrance fee including skilled or intermediate nursing services and, at the discretion of the continuing care provider, personal care services including, without limitation, assisted living care services designated by the continuing care agreement, including such services being provided pursuant to a contract to ensure the availability of such services to an individual not related by consanguinity or affinity to the provider furnishing such care upon payment of an entrance fee.

Such term shall not include continuing care at home."

"(8) 'Limited continuing care' means furnishing pursuant to a continuing care agreement:

(A) Lodging that is not:

(i) In a skilled nursing facility, as such term is defined in Code Section 31-6-2;

(ii) An intermediate care facility, as such term is defined in Code Section 31-6-2;

(iii) An assisted living community, as such term is defined in Code Section 31-7-12.2, or a supportive senior housing community, as such term is defined in Code Section 31-7-12.6; or

(iv) A personal care home, as such term is defined in Code Section 31-7-12;

(B) Food; and

(C) Personal services, whether such personal services are provided in a facility such as a personal care home or an assisted living community or in another setting designated by the continuing care agreement, to an individual not related by consanguinity or affinity to the provider furnishing such care upon payment of an entrance fee.

Such term shall not include continuing care at home."

"(15) 'Residential unit' means a residence or apartment in which a resident lives that is not a skilled nursing facility as defined in Code Section 31-6-2, an intermediate care facility as defined in Code Section 31-6-2, an assisted living community as defined in Code Section 31-7-12.2, a supportive senior housing community, as such term is defined in Code Section 31-7-12.6, or a personal care home as defined in Code Section 31-7-12."

PART III

SECTION 3-1.

This Act shall become effective upon its approval by the Governor or upon its becoming law without such approval.

SECTION 3-2.

All laws and parts of laws in conflict with this Act are repealed.